Linezolid for infective endocarditis: A structured approach based on a national database experience. Issue 51 (23rd December 2021)

• Record Type: Journal Article
• Authors: Muñoz, P.; De la Villa, S.; Martínez-Sellés, M.; Goenaga, M.A.; Reviejo-Jaka, K.; Revillas, F. Arnáiz de las; García-Cuello, L.; Hidalgo-Tenorio, C.; Rodríguez-Esteban, M.A.; Antorrena, I.; Castelo-Corral, L.; García-Vázquez, E.; De la Torre, J.; Bouza, E.
• Other Names: Jain. Nikhil section editor.
• Is Part Of: Medicine. Volume 100:Issue 51(2021)
• Publication Date: 2021-12-23
• Subjects: Enterococcus -- infective endocarditis -- linezolid -- mortality -- Staphylococcus; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000027597
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract : Abstract: Current data on the frequency and efficacy of linezolid (LNZ) in infective endocarditis (IE) are based on small retrospective series. We used a national database to evaluate the effectiveness of LNZ in IE. This is a retrospective study of IE patients in the Spanish GAMES database who received LNZ. We defined 3 levels of therapeutic impact: LNZ < 7 days, LNZ high-impact (≥ 7 days, > 50% of the total treatment, and > 50% of the LNZ doses prescribed in the first weeks of treatment), and LNZ ≥ 7 days not fulfilling the high-impact criteria (LNZ-NHI). Effectiveness of LNZ was assessed using propensity score matching and multivariate analysis of high-impact cases in comparison to patients not treated with LNZ from the GAMES database matched for age-adjusted comorbidity Charlson index, heart failure, renal failure, prosthetic and intracardiac IE device, left-sided IE, and Staphylococcus aureus . Primary outcomes were in-hospital mortality and one-year mortality. Secondary outcomes included IE complications and relapses. From 3467 patients included in the GAMES database, 295 (8.5%) received LNZ. After excluding 3 patients, 292 were grouped as follows for the analyses: 99 (33.9%) patients in LNZ < 7 days, 11 (3.7%) in LNZ high-impact, and 178 (61%) in LNZ-NHI. In-hospital mortality was 51.5%, 54.4%, and 19.1% respectively. In the propensity analysis, LNZ high-impact group presented with respect to matched controls not treated with LNZ higher in-hospital mortality (54.5% vs 18.2%, P = .04). The multivariate analysis showed an independent relationship of LNZ use with in-hospital mortality (odds ratio 9.06, 95% confidence interval 1.15--71.08, P = .03). Treatment with LNZ is relatively frequent, but most cases do not fulfill our high-impact criteria. Our data suggest that the use of LNZ as definitive treatment in IE may be associated with higher in-hospital mortality.